Kenneth B Lake, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

APN.0997653-CRNA Issued in CO

Practice address

1501 E 3Rd St
Delta, CO 81416-2815

Phone

(970) 874-7681

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Delta County Memorial HospitalGroup PAC ID 1850200601, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Delta County Memorial Hospital Hospital, Delta, CO, CCN 060071

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Delta County Memorial Hospital

  • Rural Acute Care Hospital
  • Delta, CO
  • NPI 1417935446
  Medicare reassignment Care Compare group NPD
• Delta County Memorial Hospital

  • Rural Acute Care Hospital
  • Delta, CO
  • NPI 1114180817
  NPD
• Delta County Memorial Hospital

  • Rural Health Clinic/Center
  • Delta, CO
  • NPI 1629521539
  NPD
• Studio Optics Optometric Group, Inc.

  • Ophthalmology Physician
  • Santa Clara, CA
  • NPI 1083617302
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Delta County Memorial Hospital

  • Rural Acute Care Hospital
  • Delta, CO
  • NPI 1417935446
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1003964024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10100",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814160008",
            "telephone_number": "970-874-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 E 3RD ST",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814162815",
            "telephone_number": "970-874-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "KENNETH",
        "middle_name": "B",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "APN.0997653-CRNA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000203100",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maxim A Kondratenko, DDS
• Elizabeth Kotwasinski, MSW
• Kyle Nickel MD, PC
• Lake Island Healthcare, Inc.
• Joshua Lake
• Gregory Lee Lane, D.C.
• Robert L Lang, MA
• Ryan Latter
• Laura J McCrackin, MD, PC
• Marisa V Laurora, D.O.

• Certified Registered Nurse Anesthetist in Delta, CO
• Providers in Delta, CO by specialty
• Certified Registered Nurse Anesthetist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.